Blood in urine can't be good.
August 31, 2011 9:44 AM   Subscribe

My 18 year old cat has blood in her pee, but the vet says she is fine. How can this be?

My cat has already been diagnosed with chronic renal failure last year, which means her kidneys are going downhill but not completely yet. She still looks good (clean, soft coat and bright happy eyes) is not deaf or blind or lame, and she still eats (perscription food) a drinks a decent amount.
But one night last week she was meowing loudly and constantly, and peed against the wall of my apartment. When I went to clean it the paper towel turned bright pink. I rushed her to the emergency vet and they took a blood test. They said besides her renal failure which has advanced, she is 'fine' (ie, not on death's door) but they weren't able to get her to urinate.
I took her to her regular vet the next day and got her urine tested. They also said she was 'fine' UTI or anything. The nurse suggested she could have just been stressed.
Today, she peed blood against the wall again. This time more of a rusty color.
What gives? This doesn't seem 'fine' to me but I'm also hesitant to torture her by bringing her to the vet again (I swear she hates it even more than the average animal).
Anyone experience this kinda thing? Can stress actually cause blood in the urine? Nothing in her environment has changed btw. If it is in fact stress its not from anything external. (no other pets, no moving of furniture, I'm around the same amount etc)
Please help!
posted by hellameangirl to Pets & Animals (23 answers total)
The rusty color (dried blood) generally means that whatever was bleeding has stopped. There are a number of things that could have caused that. Perhaps she passed a kidney stone; that would explain her loud and constant meowing.
posted by kindall at 9:53 AM on August 31, 2011

call your regular vet today. tell the receptionist that you still have questions from your last visit. it is their job to help you understand your cat's health problems.

a nurse telling you your cat was "probably stressed" is not a diagnosis. you need to speak to the doctor and get real answers. if they don't seem helpful, i would recommend asking friends for a recommendation for a place to take your cat for a second opinion, maybe an internal medicine specialist.
posted by virginia_clemm at 10:02 AM on August 31, 2011 [1 favorite]

Something like this happened with one of my cats, and the diagnosis was idiopathic cystitis, which is a fancy way of saying it's an inflammation of unknown origin. This page is one of the first Google search results for the term. Treatment with antibiotics and Cosequin (which I understand is just a prescription glucosamine and chondroitin supplement) seemed to get rid of the problem, though apparently it's also the sort of thing that can go away on its own.

I am not a vet and am not suggesting this is the specific problem your cat has. But yes, it's possible for cats to have blood in the urine without it being a serious illness, and it's possible for stress to trigger it. Since it's happened again since the trip to the vet, just call them and talk to them about it further.
posted by FishBike at 10:05 AM on August 31, 2011

Just as a data point -- when my 16-year-old cat, who had cancer, started peeing blood + meowing constantly, that's when we decided to put her down. My cat, like yours, was ultra-stressed by going to the vet, and had already been through so many visits, tests and treatments. I decided it would be kinder to spare her that, knowing that she was old and sick, and that any more treatments would just be prolonging the inevitable.
posted by BlahLaLa at 10:06 AM on August 31, 2011

yes stress can cause blood in cat urine (happened to Bell when we first got her)

that said its no guarantee that is the cause here. however, your kitty is very old, and seems fine otherwise, and hates the vet soooo much, perhaps the best thing is to accept the vets' words and just take care of your kitty as usual and let her be happy at home.
posted by supermedusa at 10:07 AM on August 31, 2011

Your regular vet may or may not be able to help you, if you want to truly get to the bottom of this, get a referral to an internal medicine specialist.
posted by TheBones at 10:19 AM on August 31, 2011 [1 favorite]

Note that each time you take your cat to the vet to have urine drawn for analysis, they are sticking a needle into her bladder (cystocentesis), much like amniocentisis, so it's little wonder repeated vet trips are just adding to the stress levels.
posted by nomisxid at 10:27 AM on August 31, 2011

TheBones is right. There are many things that can cause bloody urine that it doesn't sound like either of your vets have looked into. Has your cat had an ultrasound to check for stones, lesions or tumors, for instance? Especially with the renal failure, I would assume that there is an underlying condition here that you will have to decide if you want to explore or not. If she doesn't appear to be suffering, then it may not be worth it, given her age and condition and the stress it would cause her (not to mention the considerable cost).
posted by Rock Steady at 12:31 PM on August 31, 2011

Best answer: When a cat is urinating against the wall rather than on the floor, it's generally a sign of stress rather than pain. A year before I lost my 15-year-old male cat to kidney disease, he started spraying and was subsequently diagnosed with hyperthyroidism, so he was constantly ravenous and much more agitated than normal even though there were no changes to his environment. Has your kitty had a general workup lately?

Keep in mind that cats are delicate creatures: when one system starts to fail, it throws the others off balance as well, and she will start to have other seemingly unrelated problems. We didn't have to put our cat to sleep because of his kidneys, but because his liver failed. This was a hard truth to accept.
posted by tully_monster at 12:36 PM on August 31, 2011

Response by poster: Thanks everyone for your thoughtful answers. I just called a pet hospital that specializes in internal medicine, and there are supposed to call me back later. Hopefully they'll have some insight. In the mean time though, I don't want to her stress by taking to a 3rd doctor in one week, so I think I'll wait and see if the blood goes away on its own.
Tully_monster, yes she has been checked for hyperthyroidism and does not have it. I do agree maybe the kidney problems are throwing her off. I know she can't be cured of old age, and have considered putting her down. But I feel like shes still got life in her. When I was young my family had a cat who lived to be 19, and near the end her eyes were dull and sunken and she would walk very close to the current cat is not like that yet, so I'm going to take supermedusa's advice and just try and keep her happy until those worse signs appear.
posted by hellameangirl at 12:58 PM on August 31, 2011

Vet student and emergency / critical care veterinary technician here, but I haven't examined your cat.

Seconding and thirding TheBones and Rock Steady. Seek a second or third opinion, preferably with a specialist. Seek a referral from your local veterinary teaching hospital. Find a veterinarian that specializes in cats.

Hematuria - bloody urine - isn't normal, especially in a cat with chronic renal failure. It's a clinical sign of urinary tract disease. I would want radiographs and / or an ultrasound of kitty's bladder to determine the cause of the hematuria.

For most litter trained indoor cats, urinating on the wall rather than in the box is "inappropriate urination," and it is also a sign of lower urinary tract disease. Meowing loudly and constantly while inappropriately urinating on the wall is a clear indicator of discomfort or pain.

Did either vet do any bloodwork on your kitty? I would want a chemistry panel, a CBC, a PCV/TS and a urinalysis.

Good luck with your kitty!
posted by Seppaku at 1:00 PM on August 31, 2011

Response by poster: Hi Seppaku, yes, the bloodwork only showed the renal failure and the urinalysis came back negative for UTI. Maybe she had a uti that is going away by itself? For the record, she isn't meowing anymore when she pees. That was only once, and I couldn't tell if it was during the urination or after, because I didn't catch her in the act of doing it.
posted by hellameangirl at 1:07 PM on August 31, 2011

My cat was diagnosed, after a long time trying to figure it out, with feline ideopathic cystitis. (mentioned above). It really did appear to be triggered by stress. Bringing her to the vet just stressed her out more, so now I wait and make sure its a non-behavioral issue before taking her in.

What really worked for her were Composure Pet Chews. I was skeptical when presented them by the vet as they seem to be a combination of vitamins and other natural things, but it really has made a dramatic change in her well being. She takes one dog-sized one a day, which I break in thirds to be smaller. They have cat-sized ones but its the same formula and cheaper to get the dog ones and break them up. At any rate, she's more relaxed, and takes stressors with more ease than she otherwise would.

A bonus is that they taste like treats, and my normally picky cat will remind me if I've forgotten to give her one, a big difference from when she was on kitty-prozac. Everybody I've suggested it to has found some help with their anxious or easily stressed pet. I'd buy a bag if I were you and see if you see a change in her behavior. I saw behavior changes within a week or so. Even if the blood isn't something your vet sees as necessary to treat, a more relaxed cat is a bonus at any rate.
posted by gilsonal at 1:50 PM on August 31, 2011 [1 favorite]

Blood in the urine isn't something that "just goes away."
posted by TheBones at 2:38 PM on August 31, 2011

Response by poster: TheBones, I thought sometimes it did? I myself had a UTI a few years ago and didn't get a chance to get a doctor right away because it was a holiday weekend, and it did go away on its own. *shrug*
I did get a call back from the specialist, and they said they would do a radiograph and ultrasound to see if shes bleeding from the stomach or intestines, which is SURE to stress my baby out :( But they also said that if it was that, there would be blood in her stool too (theres not)
They also did acknowledge that since she is spraying (like tully_monster said above) and not, as they asked "blood spots where she sits", its probably cystitis. But wouldn't that of come out in the urinalysis? I'm so confused.
posted by hellameangirl at 3:08 PM on August 31, 2011

Has she had her blood pressure checked? Hematuria (blood in the urine) can be a sign, and is common with feline CRF. When that happened to my kitty with CRF, the vet administered fluids and put her on blood pressure meds (Fortekor here in Ireland, not sure what it is in the States). She recovered quickly; I think the inappropriate urination/hematuria actually stopped showing up a day or two after she got the fluids and first doses of bp meds. She's stable and happy now. (Btw, I found this site to be a helpful resource for info about feline CRF.)
posted by lovermont at 3:13 PM on August 31, 2011

Can be a sign of high blood pressure, that is.
posted by lovermont at 3:19 PM on August 31, 2011

They also did acknowledge that since she is spraying (like tully_monster said above) and not, as they asked "blood spots where she sits", its probably cystitis. But wouldn't that of come out in the urinalysis? I'm so confused.

Well, with my little guy who had cystitis, the only thing that was abnormal in the urinalysis was the pinkish colour of the urine. The vet made a point of showing this to me since I wasn't even sure which of my two cats had the problem, and this was pretty conclusive evidence. The actual test results came back normal, which I guess is how they know it's cystitis rather than something else.
posted by FishBike at 3:21 PM on August 31, 2011

I myself had a UTI a few years ago and didn't get a chance to get a doctor right away because it was a holiday weekend, and it did go away on its own.

Your kitty is quite elderly at 18 - the equivalent of about age 95 in human years - AND has chronic renal failure. Comparing her CRF and hematuria with your UTI is like comparing apples and airplanes.

A urinary tract infection is not the same thing as cystitis, which literally means inflammation of the urinary bladder. A UTI implies that there are bacteria present, while cystitis can be caused by a number of things.

When your vet(s) did a urinalysis, did they plan to culture it? That is standard protocol for determining if there is a bacterial infection, ie. a UTI, and what kind of bacteria is causing it.

Also, I agree with lovermont regarding blood pressure monitoring.
posted by Seppaku at 3:28 PM on August 31, 2011

Response by poster: Ahh, thanks seppaku, lovermont and fishbike. I'll call my vet and ask if they checked her blood pressure. I'm pretty sure the ER vet I first took her to did check blood pressure and it was fine, but that is kinda fuzzy memory.
I do remember asking my regular vet if the urine they tested was pink on the day I took her in, and they said no. Makes me feel crazy for see it myself.
I don't think they had said anything about doing a culture...I certainly wasn't charged for one. Seppaku, would you recommend that before the radiograph/ultrasound? Do you think the vet keeps urine samples for a week so I don't have to bring her in again?
Thank you for your expert advice!
posted by hellameangirl at 3:34 PM on August 31, 2011

Response by poster: Errr, on second thought, is a culture the only way of testing the urine? I mean, I know they did something to determine it was clean, I just don't remember them using the word, 'culture'.
posted by hellameangirl at 3:38 PM on August 31, 2011

They likely did a routine urinalysis using a test strip or dipstick. This kind of test can indicate the presence of white blood cells, protein, specific gravity, pH, blood, glucose, ketones, bilirubin, etc.. They may have looked at her urine on a microscope slide to see what kinds and types of cells there are, or if there are crystals present.

A urine culture is usually performed only when a bacterial infection is suspected. They tend to be somewhat expensive because the urine sample might be sent to an outside lab and takes time (days to weeks) to get a result. Since the idea is to grow whatever bacteria is present in your cat's bladder, it is important that they start with a fresh sample that was collected under sterile conditions. So any sample that has been sitting around for a week might have been contaminated, and in any case, is not likely to have been saved since your cat's last visit.

Remember that even though you spoke to a specialist on the phone, or more likely that specialist's receptionist or vet tech, that specialist has not taken a history of or physically examined your cat. What I would urge you to do is to write down everything you can remember about her medical history relevant to her CRF and hematuria. Try to remember detailed observations about her behavior (the crying, the wall urinating, the color of the urine, the frequency, her normal habits, anything else you can remember). Clean out her litter box, give her some fresh poop rocks and make note of what she does over the next 12-24 hours. Remember, your cat can't tell her vet what is wrong. You are the only one who can provide context clues to the clinical signs she exhibits while in the vet's office.

Obtain all of the records from her previous veterinarians, and take those, and the notes you've made, to your specialist. If she were my cat, I would be concerned. Mostly because I would want her to be comfortable given her condition and advanced age.

I hope this helps.
posted by Seppaku at 4:32 PM on August 31, 2011

Our cat, Maggie was peeing against the wall--turned out she had a bladder stone.

We were able to dissolve it with medication and a special dry cat food (Royal Canin Urinary SO 33). Ever since then, she has been fine and uses her litter box.
posted by I'm Brian and so's my wife! at 7:16 PM on August 31, 2011

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